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Historically, blood tests in secondary care were requested for defined indications and only after a detailed clinical history and examination of the patient. Like modern day imaging requests, every investigation required justification. In the 21st century, the technological evolution of healthcare has changed this dynamic. Blood analysers are now capable of processing thousands of samples every day at a fraction of their former cost, rendering careful consideration of indications a thing of the past. The potential workload of laboratories has become the expected workload, and "routine bloods" has entered the lexicon of modern day clinical practice.
Studies have shown that the NHS is a comparatively efficient healthcare system by international standards. 1 2 The UK spends less per capita on laboratory tests than other economically developed nations, with fewer errors in laboratory reporting. Growing evidence, however, shows the extent of unwarranted variation in spending by NHS acute hospitals. 3 4 Overuse of blood tests might be an important source of this variation.
Figures from the Department of Health for England show that over 230 million biochemistry and 47 million haematology investigations were requested in 2014-15 at an estimated cost of over £415m in secondary care, 5 with some estimates of up to £3bn for the NHS as a whole. 6 These represent substantial potential savings, given that around two thirds of NHS provider trusts reported financial deficits in 2015-16 and an estimated total NHS deficit of £1.85bn. 7 We think that the waste associated with the practice of...